Our primary goal is to study temporal trends in the incidence rate, causes, treatment and outcome of stroke in a biracial metropolitan population of 1.3 million of whom 15 percent are black (2000 Census). For 1/1/2005 to 12/31/2005, we will identify every hospitalized stroke and TIA at all 17 regional hospitals. We will also estimate the number of non-hospitalized strokes by screening for potential cases at 143 outpatient sites in five counties in Greater Cincinnati/Northern Kentucky. These results will be compared with data identified by the same methodology during 1993-94 and 1999 and for all cases of intracerebral hemorrhage and subarachnoid hemorrhage during 1988. In addition, we will interview 500 first-ever ischemic stroke patients, and/or their family members, to obtain detailed information including functional outcome and quality of life, current health status, medications, prior risk factors, and knowledge about stroke signs and symptoms, and will collect genetic material via buccal cells and/or blood. Finally, we will replicate the 1995 and 2000 random digit-dialing telephone surveys of 2000 persons from our population during the year 2006. The estimated 3200 strokes and 800 TIAs as well as the 2000 surveyed persons from the general population will be used to test one primary hypothesis and five secondary hypotheses: Primary Hypothesis: Temporal trends in the incidence rate of stroke will vary by stroke sub-type and race. Secondary Hypotheses: 1. The proportion of the population that knows warning signs or risk factors for stroke will improve between 2000 and 2005. 2. The proportion of patients with acute ischemic stroke treated with thrombolytic therapy will increase between 1999 and 2005. 3. The age-adjusted functional outcome and health-related quality of life after stroke will be significantly worse for blacks as compared to whites. 4. Individuals with an ischemic stroke are more likely to share genetic variants and haplotypes within the gene encoding phosphodiasterase 4D as compared to matched population controls free of stroke. 5. Surveyed people who receive stroke education with the FAST mnemonic will be more likely to know stroke warning signs after thirty days than those who receive the standard current educational message used by the Brain Attack Coalition.